Fujimoto N, Hiraki A, Ueoka H, Kiura K, Bessho A, Takata I, Hiramatsu Y, Ikeda K, Harada M
Department of Internal Medicine II, Okayama University Medical School, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
Lung Cancer. 2000 Nov;30(2):145-8. doi: 10.1016/s0169-5002(00)00147-1.
Intramedullary spinal cord metastasis is very rare in small-cell lung cancer (SCLC), and develops in only 2% of neurological disorders associated with SCLC according to previous reports. We describe here a patient with SCLC who developed intramedullary spinal cord recurrence after high-dose chemotherapy (HDCT) followed by autologous blood progenitor cell transplantation (ABPCT). A 59-year-old Japanese male was referred to us for diagnosis and treatment of an abnormal shadow on a chest radiograph. Based on transbronchial biopsy and staging procedures, he was diagnosed with limited-disease (LD)-SCLC. He received concurrent chemoradiotherapy followed by late intensification with HDCT supported by ABPCT. He achieved complete response and was discharged after receiving prophylactic cranial irradiation (PCI). However 6 months later, he noticed rapidly progressive weakness of the left lower extremity and bowel/bladder dysfunction. Magnetic resonance imaging (MRI) of the spinal cord disclosed an intramedullary tumor exhibiting an enhancement effect with Gd-DTPA at the 11-12th level of the thoracic vertebra. Immediately, radiotherapy to the spinal cord metastasis was given at a dose of 30 Gy, and his neurological disorders were completely resolved. At this time of reporting, he is doing well without recurrence. This case indicates that intramedullary spinal cord is one of the recurrence sites implicated after HDCT and PCI in LD-SCLC.
脊髓内转移在小细胞肺癌（SCLC）中非常罕见，根据以往报告，仅在2%与SCLC相关的神经系统疾病中发生。我们在此描述1例SCLC患者，其在接受大剂量化疗（HDCT）及自体造血祖细胞移植（ABPCT）后出现脊髓内复发。一名59岁日本男性因胸部X线片上的异常阴影前来我院诊断和治疗。基于经支气管活检及分期检查，他被诊断为局限期（LD）-SCLC。他接受了同步放化疗，随后在ABPCT支持下进行HDCT晚期强化治疗。他达到完全缓解，在接受预防性颅脑照射（PCI）后出院。然而6个月后，他出现左下肢快速进行性无力及肠/膀胱功能障碍。脊髓磁共振成像（MRI）显示在胸椎11-12水平有一脊髓内肿瘤，Gd-DTPA增强扫描有强化效应。随即对脊髓转移灶给予30 Gy的放疗，其神经功能障碍完全缓解。在报告时，他情况良好，无复发。该病例表明脊髓内是LD-SCLC患者在HDCT和PCI后出现复发的部位之一。
